Clinical Pharmacist driven Anemia Management Team Care with Evidence-Based Algorithm in Chronic Kidney Disease Patients

Purpose: Anemia is the most common complications and still the leading cause of death as a cardiovascular risk factor among patients with chronic kidney disease (CKD). However, there was none algorithm based Korean clinical treatment guideline and insurance criteria. Thus, this study was to evaluate the current status of anemia management in CKD patient through multidisciplinary team care (MTC) and to develop the evidence based anemia management algorithm.

Methods: Patients who were administrated at SNUH were included between October 2010 and September 2011. The primary outcome was the proportion of patients who achieved target Hb level (10-11g/dL) between the MTC and non-MTC groups. The Secondary outcome was the proportion of patients who reached the target, ferritin, and transferrin saturation (Tsat) level. When developing CKD anemia management algorithm, we reviewed clinical practice guidelines, clinical trials, recent safety reports, and domestic national health insurance criteria.

Results: A total of 131 patients were allocated to either usual care or the protocol. The difference of proportion of Hb values between the two-groups was not statistically significant. The percentage of patients below Hb target level decreased significantly during admission period (p<0.01), indicating an improvement of CKD anemia treatment by MTC. Furthermore, the percentage of patients who reached the target ferritin level increased from 34.8% to 42.9% in MTC group. Based on this assessment of current CKD anemia management, we developed the algorithm composed of four parts: 1) Anemia work-up, 2) Iron-deficient anemia treatment, 3) Erythropoietin-deficient anemia treatment, and 4) Vitamin B12 or folate-deficient anemia treatment.

Conclusion: This is the first study to evaluate the effectiveness and potential of MTC involvement in CKD anemia treatment in Korea. In addition, evidence-based CKD anemia treatment algorithms for clinical pharmacists developed for future implementation and application may improve anemia management.